Priapism in acute lymphoblastic leukemia

Unusual Presentation of Priapism Associated with Acute and Chronic Myeloid Leukemia in Two Patients: Emergency Management

Priapism is a rare urological emergency. It is rarely a telltale sign of myeloid leukemia. We report two cases of acute myeloid leukemia in a child and chronic myeloid leukemia in a young adult presenting with priapism. Puncture irrigation of the corpora cavernosa followed by systemic treatment to lower the hyperviscosity of the blood due to leukemia provided optimal outcome. Prompt emergency management is required to lower the complication of erectile dysfunction.

A review of penile metastasis

Penile cancer as primary disease is relatively rare in developed countries. The penis is a rare site of metastases in spite of its rich vascularization. Approximately 500 cases have been reported in the literature; almost 70% of primary lesions are of pelvic origin (from genitourinary or recto-sigmoid primary tumors). We describe a case of penile metastasis from lung cancer. The rarity of the event prompted us to also explore related reviews and discuss the incidence, physiopathology, diagnosis and therapy of penile secondary cancer.

Clitoromegaly and abdominal tumour as leading signs of a mediastinal non-Hodgkin lymphoma

A 2-year-old girl was admitted with clitoromegaly, mediastinal tumour and enlarged kidneys. A seventh cranial nerve palsy was associated with an increased cell count in cerebrospinal fluid. The diagnosis of a lymphoblastic lymphoma was confirmed by a cervical lymph-node biopsy. Six years after diagnosis and treatment according to the BFM protocol the girl remains in first complete remission.

Priapism in children with leukemia

A case of priapism in a child with chronic granulocytic leukemia is presented, and the English literature is reviewed. While common in adult leukemia patients, priapism is rare in children with these neoplasms. Sludging of blood in the corpora cavernosa is almost universally accepted as the mechanism behind the development of painful and persistent erection in these patients. Permanent fibrosis of the cavernosal tissue may not occur in leukemic priapism as it does in other than chronic granulocytic leukemia. Therapy directed toward the priapism is almost uniformly unsuccessful. However, the painful erection will resolve spontaneously in a matter of days with proper treatment of the leukemic process.

Priapism complicating chronic granulocytic leukemia

Since 1952 we have seen nine patients with priapism leading to a diagnosis of chronic granulocytic leukemia (CGL) and a tenth patient who gave a history of priapism when CGL was diagnosed as a result of other symptoms. Seven patients had had one or more transient episodes of prolonged erection before the diagnosis of CGL was established. All ten had high blood leukocyte counts (mean 380 X 10(9)/liter, range 186-782) in comparison with other newly diagnosed patients. We estimate the incidence of this complication at 1%-2% of all male patients presenting with CGL. Treatment of patients in this series varied greatly. Five patients were treated mainly by local measures with r without cytotoxic drugs at conventional dosage, three were treated by sapheno-cavernous bypass operations and leukapheresis followed by cytotoxic drugs at high dosage, and two were treated initially by leukapheresis alone. In general, the prompt initiation of measures designed to reduce the leukocyte count seemed more valuable than the surgical procedures employed in these patients.

Transglandular cavernosum-spongiosum shunt for leukemic priapism in childhood

Priapism is a complication rarely seen in childhood leukemia. Whatever the etiology the basic pathologic feature is obstruction to venous outflow from the corpora cavernosa. The cavernous bodies are erect but the glans penis and the corpus spongiosum usually remain soft. Various forms of treatment have been advocated for the management of this condition and have met with varying degrees of success. A boy with acute lymphocytic leukemia presented with priapism. Although radiation and chemotherapy induced prompt remission and dramatic decrease in leukocytosis, the priapism persisted. Resolution of the priapism was obtained using the transglandular cavernosum-spongiosum shunt.